Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University, College of Medicine, Taiwan, Republic of China.
PLoS One. 2013 Nov 12;8(11):e78557. doi: 10.1371/journal.pone.0078557. eCollection 2013.
Gastroendoscopy (GS) procedures are not only performed by gastroenterologists (GE) but also by hepatologists (HT) in many countries. Endoscopic biopsy (EBx) remains the gold standard for the investigation and documentation of esophago-gastro-duodenal pathology. EBx is subjectively performed by an endoscopist, and the level of skill and experience of the endoscopist may affect the quality of the endoscopic service. Reasons for this discrepancy included lack of experience practitioners to order EBx when required of GS issues between in GE and HT limit access. Ideally, services should be safe and of high quality. This study assessed the EBx/GS ratio as the endoscopic quality assurance as an index of GS services. This was a cohort study of endoscopists at Kaohsiung Chang Gung Memorial Hospital, a teaching hospital in southern Taiwan. There were 34,570 episodes of EBx in 199,877 GS procedures. The 25 endoscopists were divided into GE (n = 13) and HT (n = 12) groups, and correlation coefficients were calculated over a 14.5-year duration of intervention. The Trimmean of EBx/GS was 19.29% in 14.5 years (34570/199877 with Trimmean 0.2 percentile ratio correlations), and the Pearson correlation coefficient was 0.90229. There were significantly more EBx procedures in the GE group than in the HT group at 1 and 5 years (21.5% vs. 15.1% and 20.9% vs. 17.3%, respectively, P<0.00001). Junior GE attempted significantly more EBx than both the senior GE (24.06% vs. 20.41%, P<0.0001), and junior HT (24.06% vs. 13.2%, P<0.0001). In conclusion, quality assurance for gastrointestinal endoscopy involves numerous aspects of unit management and patient safety. Quality measures used with the EBx/GS ratio may be one of the best ways to ensure the quality of endoscopic procedures in a teaching hospital.
胃肠内镜（GS）程序不仅由胃肠病学家（GE）进行，在许多国家也由肝病学家（HT）进行。内镜活检（EBx）仍然是调查和记录食管-胃-十二指肠病理的金标准。EBx 由内镜医生主观进行，内镜医生的技能和经验水平可能会影响内镜服务的质量。造成这种差异的原因包括缺乏经验的医生在需要进行 GS 检查时未能开具 EBx 检查单，以及 GE 和 HT 之间对 GS 问题的认识有限，导致访问受限。理想情况下，服务应该既安全又高质量。本研究评估了 EBx/GS 比值作为内镜质量保证的指标，以评估 GS 服务。这是对台湾南部教学医院高雄长庚纪念医院的内镜医生进行的一项队列研究。在 199877 次 GS 检查中，共进行了 34570 次 EBx。25 名内镜医生分为 GE（n=13）和 HT（n=12）两组，在 14.5 年的干预期间计算了相关系数。14.5 年内 EBx/GS 的 Trimmean 为 19.29%（34570/199877，Trimmean 为 0.2 个百分位比率相关），Pearson 相关系数为 0.90229。在 1 年和 5 年内，GE 组的 EBx 检查明显多于 HT 组（分别为 21.5%比 15.1%和 20.9%比 17.3%，P<0.00001）。初级 GE 尝试进行的 EBx 明显多于高级 GE（24.06%比 20.41%，P<0.0001）和初级 HT（24.06%比 13.2%，P<0.0001）。总之，胃肠内镜的质量保证涉及单位管理和患者安全的多个方面。使用 EBx/GS 比值的质量措施可能是确保教学医院内镜检查质量的最佳方法之一。
